Department of Anesthesiology and Operative Intensive Care Medicine, University Witten/ Herdecke, Medical Center Cologne-Merheim, Ostmerheimerstrasse 200, D-51109 Cologne, Germany.
Minerva Anestesiol. 2013 Mar;79(3):274-84. Epub 2012 Dec 20.
Acute respiratory distress syndrome (ARDS) is a common entity in critical care medicine and associated with many diagnoses, including trauma and sepsis, which may lead to multiple organ failure and death. Pathophysiologically, increased capillary permeability is the hallmark of ARDS which is characterized by damage of the capillary endothelium and alveolar epithelium in association with impaired fluid removal from the alveolar space and the accumulation of protein-rich fluid inside the alveoli. The clinical management of patients with ARDS is even more difficult, because in the presence of capillary leakage in the lungs, adequate intravascular volume and cardiac preload are required to maintain organ perfusion. The amount of pulmonary edema fluid is, however, difficult to determine at the bedside. Pulmonary edema can be detected on physical examination and may be confirmed by chest radiography. However, it has been shown to be difficult to quantify the extent of pulmonary edema based on chest radiography or other non-invasive measures. The transpulmonary thermo-dye dilution technique has been introduced as an instrument to quantify the fluid in the pulmonary capillary bed, i.e., extravascular lung water (EVLW). This technique has shown to be potentially valuable in the management of critically ill patients and has been further developed to be clinically available nowadays as single transpulmonary thermodilution. The following review deals with the measurement of EVLW and its place in the management of critically ill patients with ARDS.
急性呼吸窘迫综合征（ARDS）是重症医学中的常见病症，与许多诊断相关，包括创伤和败血症，可能导致多器官衰竭和死亡。从病理生理学角度来看，毛细血管通透性增加是 ARDS 的标志特征，其特征是毛细血管内皮和肺泡上皮损伤，同时伴有肺泡腔中液体清除受损和富含蛋白质的液体在肺泡内积聚。ARDS 患者的临床管理更加困难，因为在肺部存在毛细血管渗漏的情况下，需要足够的血管内容量和心脏前负荷来维持器官灌注。然而，很难在床边确定肺水肿液量。肺水肿可以通过体格检查检测到，并且可以通过胸部 X 射线确认。然而，已经表明基于胸部 X 射线或其他非侵入性措施来量化肺水肿的程度具有一定难度。肺内热稀释技术已被引入作为一种仪器来量化肺毛细血管床中的液体，即血管外肺水（EVLW）。该技术已被证明在重症患者的管理中具有潜在价值，并进一步开发为目前临床上可用的单次肺内热稀释技术。以下综述涉及 EVLW 的测量及其在 ARDS 重症患者管理中的作用。
